In 2006 we used the NHANES national survey data to estimate the extent of visual impairment in the United States due to uncorrected refractive error (JAMA 2006;295:2158-2163). We subsequently followed up with an analysis of the cost of refractive correction in the United States realizing that many people already have refractive correction (e.g. eyeglasses or contacts lenses) and others need new or better refractive correction (e.g. a new pair of eyeglasses or a new contact lens prescription) to allow them to see well. Conservatively, the annual direct cost of correcting visual impairment is $4 billion per year, of which $1 billion represents the cost required to provide an initial set of glasses to those in need. In 2008 we investigated, using the NHANES data, the impact of refractive error in Americans ages 12 and older.[unreadable] [unreadable] As an adjunct to these papers, data from the National Health Interview Survey were analyzed to determine the extent of age-related eye diseases and degree of visual impairment reported by American adults. In addition, using focus group discussions, we investigated the factors which influence individuals to seek out preventive eye care services. Our findings indicate that communication between patients and their primary health care providers could facilitate improved access to eye care.